Despite Economic Crisis, Thailand Continues Bold Fight Against AIDS

BANGKOK, Thailand —  Throughout the 1980s, as AIDS ravaged millions of lives from the Americas to Africa, a mysterious thing was happening in Asia. The world’s most populous continent was so untouched that scientists wondered if Asians had a gene that made them immune to the disease.

But the late arrival of AIDS in Asia turned out to be a medical fluke. Africa still has the vast majority of AIDS cases, but Asia has developed the world’s fastest-growing problem--at the same time when economic crisis is forcing governments to slash spending across the board, including on health care.

In Thailand, 2.3% of adults are infected with HIV, the virus that causes AIDS, and the disease kills more than 50,000 people a year. However, Thailand has made fighting AIDS a top priority and, even though its economy is in tatters, has managed to maintain spending on AIDS education at $80 million a year.

Its program is changing people’s behavior, and international officials consider it a model for the developing world.

“Thailand is a good example that if you do something right, you can actually make a significant impact on the way the AIDS epidemic unfolds,” said Steven Krause, a U.N. AIDS official in Bangkok.

In the developed world, recent medical advances have drastically reduced the number of AIDS deaths. In the U.S., AIDS deaths fell 47% last year. For the first time since 1990, the disease is no longer ranked among the top 10 killers in the nation.

But the United Nations reports that 4 million people in India and 400,000 in China are living with HIV or AIDS. By 2000, health researchers say, 12 million Asians could be infected, and the cost to Asia’s hurting economies could reach $52 billion, most of it through the loss of a work force killed or disabled in the prime of life.

Aggressive Campaign Reduces Infection

Some Asian countries are largely ignoring the problem for political or religious reasons. Others are fighting a losing battle because of their poverty.

AIDS is primarily a heterosexual disease in Southeast Asia. Thailand, the hardest-hit country in the region, had no recorded AIDS cases in 1984 and only a handful in the late 1980s.

But by 1991, its military government already had begun pouring resources into research and education in an unusual attempt to change sexual behavior in a nation where many men take “minor”--or secondary--wives and most, at one time or another, visit a prostitute.

It set up a national surveillance system to track the disease and study sexual activity. It made a test case of the 60,000 young male conscripts who enter the army annually.

Free condoms were provided to brothels and massage parlors. Some establishments that did not enforce 100%-condom-use policies were shut down. TV and radio stations ran explicit AIDS-prevention commercials every hour. Teachers spoke openly with students about the dangers of unsafe sex.

Nearly 1 million Thais test HIV-positive, and poverty caused by economic problems is pushing more people toward prostitution or drugs, increasing their risk of contracting AIDS. Still, there is evidence that the government’s effort is changing sexual behavior, which in turn is slowing the rate of infection.

Sex Industry Blamed for Disease’s Spread

In northern Thailand, where more than four of every 10 prostitutes test HIV-positive, 58% of all 21-year-old males reported visiting a “sex worker” in 1991; 39% did not use a condom. By 1995, the percentage of 21-year-olds who had bought sex during the year had dropped to 24% and that of non-condom users to 7%.

Thai officials say the decline in visits to prostitutes is probably the result of the overall education program and growing awareness that commercial sex is dangerous.

By the standards of sub-Saharan Africa, which has 21 million HIV-positive people and has recorded 83% of the world’s AIDS deaths, Asia’s infection rate is still relatively low. But the rapid spread of AIDS since 1990 and the fact that Asia is home to two-thirds of the world’s people raise fears that the continent will end up leading the globe in the number of AIDS cases, health officials say.

The sex industry in Southeast Asia is booming. After studying Thailand, Indonesia, Malaysia and the Philippines, the International Labor Organization found that in some countries, up to 1.5% of the total female population is involved in prostitution. In Thailand, the ILO reported, commercial sex accounts for 14% of the country’s gross domestic product.

Father Joseph Maier runs a 31-bed AIDS hospice in Bangkok, and it is always full. He moves among gaunt, withered bodies with gnarled fingers, lesions and purple lips. He hears the labored breathing and deep, raspy tubercular coughs.

Bangkok has so many people with AIDS that “if I had 20 acres of land to build on, I could take them in by the thousands and God would send the food,” he said.

He paused next to Tim Sitkoontod, 34, bone-thin, her voice a whisper. Like most of the women here, she was infected by her husband, who had contracted AIDS from a prostitute. Her husband visited her twice in the hospice, then stopped coming when the disease robbed her of her beauty and gave her a death-like pallor and a body riddled with sores.

Does she hate him for infecting her and abandoning her?

“No,” she said. “He is dead, of AIDS. You cannot hate a dead man.”

Tim said that she too was preparing for death: “Father Joseph has given me good care, but I don’t think I will leave here alive.”

Somsak Glaiurob, 44, another patient at Maier’s Mercy Center, said he went to brothels. “I didn’t think there was danger, so I didn’t wear condoms,” he said. “Of course, now I regret my stupidity very much.”

The continuing spread of AIDS in Southeast Asia is indirectly linked to the region’s economic crisis. As desperation increases, more people are turning to drugs, sociologists say, and as joblessness soars more are being forced to seek a livelihood in the commercial sex industry.

The response of governments varies greatly.

Myanmar’s military rulers have mostly ignored the crisis that has infected two-thirds of the country’s drug users.

Indonesia and Malaysia, predominantly Muslim, have talked little about it for fear of arousing religious sensibilities. The Roman Catholic Church in the Philippines has campaigned against the government’s anti-AIDS program and fought the distribution of free condoms.

Laos and Cambodia are too poor to muster funds for a counterattack. Vietnam can afford to spend only $3.50 per capita a year on health care but, like Thailand, has made AIDS a major issue.

AIDS Affects All Strata of Society

Dr. Wiput Phoolcharoen, director of the Thai government’s AIDS division, said the disease has “tremendous social implications.”

“It affects the aging, whose children die and are no longer there to take care of them,” he said. “It affects children, who suddenly have no parents and become street kids and are forced to become sex workers to survive. It affects the very structure of family and community, which are central to life in Asia.”

“When we opened the hospice four years ago, the community said, ‘Great idea. Just don’t put it here,’ ” Maier said. “But the opposition has been silenced ever since their children and nephews and nieces suddenly started coming down with AIDS.”